Hip fractures represent a major clinical burden among older adults and are increasingly important as population ageing continues worldwide. Recent global analyses have demonstrated a substantial rise in the incidence and prevalence of hip fractures among older individuals, with population ageing identified as an important contributor to this trend. Older women constitute a particularly vulnerable group because of the combined effects of advanced age, reduced bone strength, impaired mobility and increased susceptibility to falls [1].

The clinical consequences of a hip fracture extend beyond the local skeletal injury, frequently resulting in loss of mobility, functional dependence and increased mortality. These concerns become particularly pronounced in centenarians, in whom physiological reserve is limited and multimorbidity is common. A recent systematic review and meta-analysis involving 6,970 centenarians with hip fractures reported a pooled one-year mortality of 53.8% and a complication rate of approximately 50.5%, underscoring the substantial vulnerability of this population following hip fracture [2]. Moreover, contemporary population-based evidence indicates that centenarians undergoing hip-fracture surgery have greater postoperative mortality than octogenarians and nonagenarians, with acute kidney injury, respiratory complications, pneumonia and sepsis contributing importantly to adverse outcomes [3].

Decision-making regarding operative treatment in extremely elderly patients therefore requires consideration of physiological reserve and comorbidity in addition to chronological age. A recent systematic review and meta-analysis of 462,699 patients undergoing hip-fracture surgery identified advanced age, higher American Society of Anesthesiologists status, chronic renal failure, low haemoglobin concentration and heart failure among factors associated with increased early mortality. These findings emphasize the importance of individualized preoperative risk assessment and optimization in patients presenting with multiple medical vulnerabilities [4]. Renal dysfunction may be particularly relevant in patients undergoing fixation of intertrochanteric fractures; a 2024 study of elderly patients treated with proximal femoral nail anti-rotation fixation found that more advanced chronic kidney disease was associated with poorer long-term survival following intertrochanteric fracture [5].

At the same time, extreme age alone does not necessarily preclude surgical treatment. Contemporary recommendations emphasize coordinated orthogeriatric management incorporating assessment and optimization of medical comorbidities, perioperative care, rehabilitation and functional goals. Recent expert consensus has further highlighted multidisciplinary co-management as an important component of optimal hip-fracture care in older adults [6]. In this context, the management of a hip fracture in a centenarian requires a balance between the substantial risks associated with surgery and the consequences of prolonged immobility and nonoperative treatment.

We report the operative management of a left intertrochanteric femur fracture in a 107-year-old female with significant perioperative medical risk. The case illustrates the importance of individualized clinical assessment, perioperative optimization and multidisciplinary decision-making when considering surgical stabilization in a patient at an exceptionally advanced age.

CASE PRESENTATION A 107-year-old female presented with a left intertrochanteric femur fracture requiring definitive orthopedic management. Given the patient’s exceptionally advanced age, the initial clinical assessment focused not only on the fracture but also on her overall physiological reserve and perioperative risk. The available preoperative evaluation identified significant medical vulnerabilities, particularly anemia and impaired renal function. Hemoglobin measurements ranged from 8.1 to 9.2 g/dL, while serum creatinine was 2.11 mg/dL and blood urea was 85 mg/dL. These abnormalities indicated limited physiological reserve and necessitated careful assessment before proceeding with operative treatment. The patient underwent comprehensive preoperative cardiopulmonary and medical evaluation. In view of her advanced age and associated medical risk, perioperative management was planned with particular attention to anesthetic safety, hemodynamic stability, and postoperative monitoring. Following multidisciplinary clinical assessment, the potential benefits of fracture stabilization were considered to outweigh the anticipated perioperative risks, and operative management was selected. The patient underwent closed reduction and internal fixation of the left intertrochanteric femur fracture using a proximal femoral nail (PFN). The procedure was performed with individualized anesthetic planning and close perioperative monitoring. Following surgical stabilization, the patient remained under inpatient observation with continued clinical and hemodynamic monitoring and appropriate postoperative care. The documented postoperative course was satisfactory enough to permit discharge after surgical stabilization and inpatient monitoring. No additional postoperative complication is documented in the information currently available. The case demonstrates that, even in a patient aged beyond 100 years with substantial perioperative risk, operative stabilization may be considered when the overall clinical condition, anticipated benefits, and treatment goals support surgical intervention.

Hip fracture in a centenarian represents a particularly demanding clinical scenario because chronological age is accompanied by reduced physiological reserve, multimorbidity and increased susceptibility to perioperative complications. Contemporary evidence supports the concept that management should be based on the patient's overall physiological condition, comorbidity burden and anticipated treatment goals rather than age in isolation. In a multicentre cohort of centenarians undergoing surgery for hip fracture, Jang et al. reported substantial mortality during follow-up, while pre-injury ambulatory status emerged as an important determinant of survival. These findings emphasize that functional status before the fracture may be more informative for treatment planning than chronological age alone [7]. Similarly, registry-based data from specialized geriatric trauma centres have demonstrated that centenarians remain a particularly vulnerable population, although surgical treatment is feasible and meaningful survival after fracture can be achieved in a proportion of patients [8].

The present patient was 107 years old and had clinically relevant perioperative risk factors, including anemia and renal impairment. Her hemoglobin concentration ranged from 8.1 to 9.2 g/dL, with a serum creatinine of 2.11 mg/dL and blood urea of 85 mg/dL. These findings illustrate the complexity of preoperative assessment in an exceptionally elderly patient. Recent literature emphasizes that hip fracture should be regarded as a time-sensitive systemic condition in older adults, with optimization directed toward potentially reversible abnormalities while avoiding unnecessary delays to definitive fracture management. Important areas of optimization include anemia, cardiovascular stability, infection, analgesia, delirium prevention and individualized anesthetic planning [9]. Thus, the presence of medical abnormalities should prompt targeted optimization rather than automatically resulting in exclusion from operative treatment.

The timing of surgery is particularly relevant because prolonged immobilization after hip fracture can contribute to a cascade of adverse events. A recent retrospective study of older adults undergoing hip fracture repair found that each additional day before surgery was associated with increased 30-day, 90-day and 365-day mortality, as well as greater odds of prolonged hospitalization and readmission [10]. Although the exact interval between presentation and surgery in the present case is not available in the documented information, the decision to proceed with operative fixation following medical assessment is consistent with the contemporary principle of balancing necessary physiological optimization against the potential harms of avoidable surgical delay. Importantly, this principle is particularly pertinent in a 107-year-old patient, in whom prolonged immobilization may have substantial consequences.

Anesthetic management constitutes another major consideration in extremely elderly patients. Advanced age, impaired renal function and anemia may reduce tolerance to physiological perturbations associated with anesthesia and surgery. A recent retrospective study of geriatric orthopedic patients found that perioperative factors, including transfusion requirements, were associated with mortality, while mortality did not differ significantly between the anesthetic techniques examined [11]. A systematic review of randomized trials has likewise suggested that regional and general anesthesia have broadly comparable effects on major postoperative outcomes, although regional anesthesia may be associated with shorter operative duration, reduced blood loss and shorter hospitalization [12]. Consequently, the choice of anesthetic technique should be individualized according to the patient's comorbidities, physiological reserve, surgical requirements and anesthesiologist's assessment rather than being determined solely by chronological age.

For the present intertrochanteric fracture, closed reduction and internal fixation with a proximal femoral nail was selected. Intramedullary fixation is an established surgical strategy for intertrochanteric femoral fractures, and contemporary evidence continues to support several fixation constructs rather than identifying a single universally superior implant. A 2025 network meta-analysis of randomized controlled trials evaluating 15 implant types found differences between fixation systems in selected mechanical and non-mechanical complications but did not demonstrate overall superiority of one implant across all outcomes [13]. More recent comparative evidence involving proximal femoral nail-based constructs similarly indicates that implant selection should be guided by fracture characteristics and patient-specific considerations. In a patient with extreme age and substantial perioperative risk, a fixation strategy that provides stable fracture stabilization while facilitating recovery without the physiological burden of arthroplasty may therefore be a reasonable approach when technically appropriate.

The postoperative phase is equally important because successful fixation represents only one component of recovery following geriatric hip fracture. Early mobilization has been associated with clinically important outcomes after hip fracture surgery. Kristensen et al. reported that greater mobilization during the first postoperative day was associated with lower 30-day mortality, supporting the importance of initiating rehabilitation as early as clinically feasible [14]. In the present case, the documented postoperative course permitted discharge following stabilization and inpatient monitoring. However, the available records do not provide sufficient information regarding the patient's postoperative walking capacity, rehabilitation requirements or longer-term functional outcome. Therefore, the significance of the postoperative course should be interpreted primarily as successful completion of operative stabilization and inpatient recovery rather than evidence of complete functional recovery.

Multidisciplinary management is particularly valuable in patients at the extreme end of the age spectrum. Orthogeriatric co-management integrates orthopedic treatment with assessment and management of medical comorbidities, perioperative complications, rehabilitation and discharge planning. Evidence from long-lived patients aged 90 years and above has demonstrated that orthogeriatric co-management was associated with lower 30-day mortality and improved early postoperative mobility compared with conventional consultation-based care [15]. This approach is especially relevant to the present case because the patient's advanced age, anemia, renal dysfunction and cardiopulmonary vulnerability required consideration of multiple interacting perioperative risks rather than isolated orthopedic management.

The principal limitation of this case is that it represents a single patient and therefore cannot establish the safety or superiority of operative treatment in centenarians as a group. In addition, the currently available documentation does not provide complete information regarding pre-fracture functional status, exact fracture classification, anesthetic technique, intraoperative blood loss, duration of surgery, postoperative mobilization or long-term follow-up. These factors are important because functional status and postoperative recovery are clinically meaningful outcomes in extremely elderly patients. Nevertheless, the case provides a clinically relevant example of operative management in a 107-year-old patient with substantial medical risk and demonstrates the importance of individualized assessment when determining whether surgical stabilization is appropriate.

Operative management of an intertrochanteric femur fracture can be considered even in exceptionally elderly patients with substantial perioperative risk when individualized clinical assessment supports surgical intervention. In this 107-year-old female, careful evaluation of physiological status, medical comorbidities and perioperative risk facilitated successful fracture stabilization using proximal femoral nailing. The case emphasizes that chronological age alone should not be regarded as an absolute contraindication to surgery; rather, treatment decisions should be guided by overall physiological reserve, anticipated benefits, functional objectives, multidisciplinary optimization and individualized anesthetic and postoperative management.